Lady Forester Community Nursing Home

Lady Forester Community Nursing home is care home providing nursing care to a maximum of 35 people. At the time of the inspection, 25 people were using the service. Accommodation is provided in one adapted building. The provider also operates a domiciliary care service to people living in their own homes. At the time of the inspection, four people were receiving assistance with their personal care needs. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People were protected from the risk of abuse because the provider’s systems ensured staff were suitable to work with people. People told us they felt safe and risks to people’s safety and well-being were assessed and monitored. There were sufficient numbers of staff to meet people’s needs in a safe way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People said staff always asked for their consent before helping them.

People had their needs assessed and were supported by staff who had the skills and experience to meet their needs. Staff monitored people’s health and well-being and worked with other professionals to make sure they received the care and treatment they needed. People’s nutritional needs were met and everyone we spoke with was happy with the food and drinks provided.

People were supported by kind and compassionate staff who ensured they were fully involved in decisions about their care. People were treated with respect and their right to privacy was understood and respected by staff. People were supported to remain as independent as possible.

People received a service which met their needs and preferences. There were opportunities for social stimulation and people could see their friends and family whenever they wanted. People were treated as individuals and chose how they spent their time. People and their relatives felt confident and comfortable to discuss any concerns with staff. People could be confident that their wishes for end of life care would be respected by staff.

The home was well led by the provider, a registered manager and experienced management team. People could be confident the systems in place to monitor standards of care, respond to concerns and plan on-going improvements were effective. Staff were well supported and motivated. This led to a happy and inclusive environment for people to live in.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement. (Report published October 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this unannounced inspection on the 30 and 31 August 2018 they were providing nursing and accommodation to 25 people and personal care to a further six people.

Lady Forester Community Nursing Home had a registered manager in place but they were not present during this inspection’s site visit owing to pre-arranged annual leave. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was supported day to day by a manager who was present throughout this inspection.

Following our last inspection in October 2015 we published our report in December 2015. At that inspection we rated Lady Forester Community Nursing Home as ‘Good’ overall. However, we identified areas of improvement were needed to be made in the relation to the key question ‘Responsive’. Improvements were needed to be made in relation to engaging people in activities.

At this inspection, we identified three breaches of regulations. These were in relation to; lack of person centred care planning, failure to make the required notifications and ineffective quality monitoring and governance. In addition, we found other areas that required improvement.

People did not have up to date care and support plans that reflected their needs and preferences. The provider had failed to make the necessary notifications that they are required to do so by Law. The provider’s quality monitoring systems were not sufficient enough to identify and make improvements when they were needed.

People and staff members sometimes felt that they were rushed and that there was not enough time to spend positively interacting with those receiving care and support.

People could not be assured that their rights were upheld in relation to the Mental Capacity Act 2005 (MCA) as the provider did not follow recognised best practice when assessing people’s needs.

When needed people had individual assessments of risk based on their medical needs. However, some of these assessments incorrectly calculated meaning some people had an inaccurate indication of the care they required.

People did not always receive support at times when they were upset and distressed.

People did not have information presented to them in a way they could access and understand as the provider had not implemented the principles of the Accessible Information Standards.

People’s human rights and protected characteristics, like faith and disability, were not fully supported or promoted as important information regarding their lives so far had not been included in their care planning.

People were safe from the risk of abuse and ill-treatment as staff knew how to recognise and respond to concerns. Any concerns raised with the management team were acted on appropriately. The provider followed safe recruitment procedures when employing new staff members. People received their medicines, as prescribed, with the assistance of staff who were competent to safely support them.

New staff members received an introduction to their role and were equipped with the skills they needed to work with people. Staff members had access to on-going training to maintain their skills and to keep up to date with changes in adult social care.

People’s privacy was respected by those providing assistance. People and their relatives were encouraged to raise any concerns or complaints. The provider had systems in place to address any issues raised with them.

The management team at Lady Forester Community Nursing Home was approachable and supportive. People’s suggestions and comments were valued by the provider. Staff members believed their opinions and ideas were listened to by the provider and, if appropriate, implemented.

The provider learnt from incidents and accidents and worked with people and families to minimise the risk of reoccurrence if things had gone wrong.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People felt safe because their rights and dignity were respected when making decisions about any risks that they may wish to take. People were safe because the provider had a system to manage accidents and falls and learnt from them, so they were less likely to happen again. For example, the provider kept records that analysed and monitored falls. They also detailed what actions were taken to assist people to maintain their safety after a fall.

Staff understood about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and how they would be put this into practice. No DoLs applications had been submitted but the provider was undertaking a review of this.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people living in the home were protected from avoidable harm, abuse and breaches of their human rights.

The people considered they were kept safe and were listened to. We observed that people were free to go about their daily routine as they wished. One person told us, 'I feel happy here. The staff are always on hand to help me and I can do as I please.' A relative said, 'Since my mother has deteriorated the staff have helped me enormously. They communicate well with me and I know my mother is safe.'

Is the service effective?

People we spoke with said they felt confident discussing their health needs with staff. They said their health was regularly monitored to identify any changes that may require additional support or intervention such as referral to the GP or dietician. We looked at records that showed referrals were quickly made to health services when people's needs changed. Records noted that relatives were kept informed. A relative commented, 'I was informed of all visits made by GPs and the recommendations made by them.' Another said, ' X improved, thanks to the swift action taken by the staff at the time, calling the doctor and keeping me fully informed and updated at all times. I was confident X was receiving appropriate, dignified and gentle care day and night.'

Staff we spoke with demonstrated they had the skill and knowledge to meet people's assessed needs, preferences and choices at all times. Staff had discussed and recorded important issues around consent to care and when people did not want to be treated. They had also explored whether people's family were to be included in decisions and this was respected. People told us they were happy to discuss their personal preferences with staff. They said that staff kept an eye on them and got help very quickly if they were unwell. This meant people were supported to maintain good health, have access to health care services and received on-going support.

Is the service caring?

The people we spoke with told us they felt that their dignity was respected and they were assisted to live their life as they wished. Staff took the time to find out people's personal social histories. Staff we spoke with knew people's needs well and how they wished to be cared for. This meant that staff cared about the person as an individual and were concerned about their well-being.

People and those that mattered to them were encouraged to make their views known about their care. A relative we spoke with confirmed that staff considered their views were important and were respected. This meant that people were listened to and they felt that their views mattered.

Is the service responsive?

The registered manager and the team of staff demonstrated a clear understanding of the importance of communicating with people and their relatives to find out their aspirations, preferences and diverse needs. Care records detailed how people's individual needs were regularly assessed and met. Detailed nutritional records were kept with clear instruction for staff.

Staff told us that a situation would be considered under the Mental Capacity Act 2005 if people did not have capacity, so that decisions would be made in their best interests. The way staff interacted with people showed that they actively sought and listened to people's views and decisions. This meant people were supported to express their views and be actively involved in making decisions about their care and support.

Is the service well led?

The management and staff demonstrated values that included involvement, compassion, dignity, respect and independence. Staff we spoke with showed they understood this as they discussed their role and responsibilities in their work. This meant the service promoted an open culture that was centred on the individual and empowered them to take control of their life as they were able.

Developments in guidance and best healthcare best practice were used as an opportunity for learning and improvement. For example, the service was exploring how they could provide dementia care for people. This would mean people would be assured of appropriate management and decision making on their behalf if they developed a dementia related illness.

Concerns were listened to. The provider hadn't received any complaints but people told us they would 'Go straight to the manager' if they were unhappy.

The provider had systems in place to assess and monitor that staff had the right competencies, knowledge, qualifications, skills and experience to meet the needs of people. This meant staff were motivated to carry out their role and to meet people's needs.

At our inspection we found that people who used the service and their relatives were involved in the care and there were suitable measures in place to ensure people's nutritional needs were met. Staff had a good understanding of the care needs of individual's living at the home.

People told us that they enjoyed the food and drink provided within the home. They were able to choose what they wanted to eat from the menu and where they preferred to eat a meal.

Building works were in progress to improve the facilities at the home. The home was clean, tidy and well maintained. Regular safety and maintenance checks were being carried out to make sure that the premises were safe and suitable for people's needs.

Staff provided health and social care support well. Community services were accessed to support people when necessary.

People who lived in the home or used the domiciliary serviced told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the service had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. People's relatives told us that staff were around and available to talk to when they visited. They said that the staff were friendly and always acted professionally. One person said that, 'It's a very nice place to be' and another said, 'The staff are very helpful'.

People we spoke with said their comments were listened to. A visitor said they would not hesitate to talk to staff if something was wrong. The home's management held regular meetings with the people who use the service to find out what people thought about how their care was delivered.